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Episode
This Fixes Mitochondria, Drops Cortisol, and Shrinks Visceral Fat
~80 min
Episode Brief·YouTube

This Fixes Mitochondria, Drops Cortisol, and Shrinks Visceral Fat

Thomas DeLauer
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TL;DR

The four things you'd lose by not watching

4 items

TL;DR

The four things you'd lose by not watching

4 items
1

A 'stuck metabolism' isn't broken, but rather stuck in the wrong mode due to mitochondrial dysfunction, metabolic inflexibility, and hormonal misfires (thyroid and cortisol).

2

To fix a stuck metabolism, focus on restoring redox balance (NADH to NAD ratio), improving thyroid conversion, and syncing cortisol rhythm.

3

Strategies include strategic carbohydrate refeeds, specific supplements (niacinamide, glycine, polyphenols, methylene blue), targeted nutrient intake (selenium, zinc, tyrosine, iodine), and lifestyle adjustments like morning light exposure, cold showers, and contrast training (alternating high-stress days with recovery days).

4

Prioritize micronutrients over strict calorie restriction initially, and use tools like red light therapy and specific breathing techniques to support hormonal balance.

Protocols

Concrete recipes — what, when, how much, and why

5 items

Carbohydrate Refeeds for Redox Balance

WhatIncorporate clean carbohydrate refeeds once or twice a week to recycle NADH back into NAD and reset thyroid and leptin signals.
WhenOnce or twice a week.
Dose100-200 grams of carbohydrates on refeed days. Otherwise, keep carbs around 100 grams per day. Keep fat content lower on refeed days.
For whomIndividuals with a 'stuck metabolism' who are generally keeping carbohydrate intake low.
WhyA high NADH to NAD ratio signals energy overload to mitochondria, stopping new mitochondrial biogenesis. Refeeds help restore this balance, signaling to the body that energy is available, and improving thyroid and leptin sensitivity.
CaveatsEnsure carbohydrates are 'clean' (root vegetables, sweet potatoes, carrots, parsnips, some fruit, good quality rice). Avoid spiking insulin with high fat alongside high carbs.

The speaker explains that while he generally advocates for lower carbohydrate intake to manage insulin, strategic carbohydrate refeeds are crucial for a stuck metabolism. The goal is to address the high NADH to NAD ratio, which mitochondria interpret as an energy overload, leading them to cease building new mitochondria. By introducing clean carbohydrates, the body can recycle NADH back into NAD, effectively resetting this signal. This also helps restore proper thyroid and leptin signaling, which are often impaired in a stuck metabolic state. The recommendation is to keep daily carbohydrate intake around 100 grams for most days, but on 1-2 refeed days, increase it to 100-200 grams. It's important to keep fat intake lower on these refeed days to avoid a combined spike in insulin and fat storage.

So once or twice a week, you're going to actually add a clean carbohydrate refeed. Now, you might be eating carbohydrates already, but I would recommend that you reduce the carbohydrate intake overall. And then once or twice a week, have clean carbs.

Also said
“What this does is this helps you recycle NADH back into NAD and it resets your thyroid and leptin signals.”— Explains the primary mechanism of action.
“Keep your fat content lower when those carbohydrates are in place so you're not spiking insulin along with fat.”— Provides an important caveat for implementation.

Low-Dose Methylene Blue Supplementation

WhatTake a low dose of methylene blue to act as an alternative electron carrier, bypassing damaged parts of the mitochondrial chain.
WhenA couple of days per week, in the morning, specifically on workout days.
Dose2-4 milligrams.
For whomIndividuals looking to support mitochondrial health and energy production, especially those with a stuck metabolism.
WhyMethylene blue acts like 'jumper cables' for mitochondria, allowing electron transport to continue even if parts of the mitochondrial chain are damaged, thereby rekindling mitochondrial function.
CaveatsOnly use at very low doses (2-4mg). The speaker notes its good safety profile at this dose. Not intended for indefinite use.

Methylene blue, at very low doses, functions as an alternative electron carrier within the mitochondria. In a 'stuck metabolism,' damaged mitochondria struggle to efficiently pass electrons down the chain to produce energy. Methylene blue bypasses these damaged sections, effectively providing a shortcut for electron flow. This helps to 'rekindle' the mitochondria and restore energy production. The speaker emphasizes that only a small amount (2-4mg) is needed and that it should be taken in the morning, ideally on days when one is working out, to maximize its benefit for mitochondrial function. It's not meant for continuous, long-term use.

Another thing you can do is add a low dose of methylene blue. All you'd want to do is add like two to four milligrams. You do not need much of this stuff, okay?

Also said
“As an alternative electron carrier, it's literally bypassing damaged parts of the mitochondrial chain. So, think of it like jumper cables for your mitochondria in this broken system.”— Provides a clear analogy for its mechanism.
“It is going to help the mitochondria rekindle. You don't need to take it forever.”— Clarifies the purpose and duration of use.

Periodic 24-36 Hour Fasting

WhatEngage in a 24 to 36-hour fast to raise NAD levels, trigger autophagy, and clear damaged mitochondria.
WhenOnce or twice per week.
Dose24-36 hours.
For whomIndividuals seeking to reset their metabolism, especially those who are more advanced in their health practices.
WhyFasting increases NAD, which is crucial for signaling energy availability and triggering cellular cleanup processes like autophagy and mitophagy, removing damaged mitochondria and improving overall mitochondrial health.
CaveatsFollow the fast with a protein-rich meal, and then a few hours later, a higher carbohydrate meal (e.g., 100g of root vegetables) to restore thyroid signaling effectively. Avoid back-to-back fasting days or extreme calorie restriction to prevent chronic cortisol elevation.

Fasting, particularly for 24-36 hours, is recommended to boost NAD levels. NAD plays a vital role in cellular energy sensing and signaling. When NAD levels rise, it triggers autophagy, a process where cells clean out damaged components, and mitophagy (a specific type of autophagy), which removes damaged mitochondria. This cellular cleanup is essential for renewing mitochondrial function. The speaker advises breaking the fast with a protein-rich meal, and then a few hours later, consuming a moderate amount of clean carbohydrates (around 100g from sources like root vegetables). This specific sequence is designed to make the body highly sensitive to thyroid signaling after the fast, helping to rekindle thyroid function more effectively. It's crucial to integrate this with the 'recovery oscillation' principle, ensuring that fasting days are not followed immediately by other high-stress days.

Then once or twice per week, do a 24 to 36-hour fast. Okay? So, we're talking about keeping carbohydrates low for the most part, 100 grams a day. Then two days a week, do like a 200 g of carbs day. And then once, maybe twice per week if you're more advanced, do a 24-hour fast.

Also said
“It goes back to NAD again. Doing a fast raises this NAD. It triggers autophagy and it clears the damaged mitochondria through a process called mphagy.”— Explains the key mechanisms of fasting for metabolic health.
“If you follow that fast with a higher carbohydrate meal, not right when you break the fast, but maybe a few hours after you break the fast... that is going to restore thyroid signaling at a period of time when you are very sensitive to it after a fast.”— Details the specific timing and composition of the post-fast meal for optimal thyroid signaling.

Metabolic Morning Ritual

WhatEstablish a morning routine including sunlight exposure, a cold rinse, and a protein-rich breakfast with key nutrients.
WhenEvery morning, first thing.
DoseSunlight: first thing in the morning; Cold rinse: 60 seconds; Breakfast: protein-rich with specific nutrients.
WhyThis ritual boosts thyroid output, sets circadian rhythm, and provides essential nutrients for thyroid conversion and overall metabolic function.

The speaker recommends a specific morning ritual to kickstart metabolism and align circadian rhythms. This involves getting sunlight exposure first thing in the morning, followed by a 60-second cold shower or rinse. The cold exposure increases norepinephrine and enhances D2 enzyme activity, which is crucial for thyroid hormone production. The breakfast should be protein-rich and include key nutrients like selenium and tyrosine, which can be obtained from foods like eggs, salmon, and Brazil nuts. This combined approach simultaneously boosts thyroid function and aligns the body's natural rhythms, providing a powerful metabolic reset from the start of the day.

Then I want you to build a metabolic morning ritual. It sounds dorky and weird, but it works. A little sunlight exposure first thing in the morning. Then I want you to do that cold rinse, like just a cold shower, something simple. Protein rich breakfast, okay?

Also said
“By doing this, you've boosted thyroid output and circadian rhythm in one go. Like one clean sweep in the morning as a simple routine.”— Highlights the comprehensive benefits of the ritual.
“You could add your selenium supplements. You could add your tyrrosine. Or you can literally just eat some eggs with maybe a little bit of salmon, some locks, and like two Brazil nuts, okay? And that's going to get you the nutrients you need.”— Provides concrete examples of how to implement the nutrient aspect of the breakfast.

Cortisol Rhythm Synchronization

WhatImplement daily practices to sync cortisol rhythm: morning light, midday movement/breathing, and evening relaxation.
WhenThroughout the day: morning, midday, and evening.
DoseMorning light: within 30 minutes of waking; Midday: short walks or physiological sighs; Evening: kill blue light 2 hours before bed, magnesium glycinate (300-400mg), taurine (1g), box breathing.
WhyCortisol is essential but its timing is critical. Syncing its natural rhythm (high in morning, low at night) prevents chronic elevation, which otherwise promotes fat storage and metabolic dysfunction.

The speaker emphasizes that cortisol itself is not the enemy, but its timing is. The goal is to ensure cortisol spikes naturally in the morning and drops at night. This is achieved through several practices: First, getting morning light exposure within 30 minutes of waking is crucial for resetting the circadian rhythm and initiating the natural cortisol spike. Midday, short walks or physiological sighs (as described by Andrew Huberman) can help lower cortisol, especially after caffeine intake, by activating the vagal tone and promoting CO2 release. In the evening, promoting relaxation is key. This includes killing blue light 2 hours before bed, supplementing with magnesium glycinate (300-400mg) and taurine (1g), and practicing simple box breathing to activate the parasympathetic nervous system. The speaker shares his personal experience of chronic stress from a demanding job, highlighting the importance of actively engaging the parasympathetic system to prevent metabolic issues.

Remember that cortisol isn't the enemy. Okay? Timing is. So morning light within 30 minutes of waking resets the circadian rhythm and it spikes cortisol where it belongs.

Also said
“You can add breath work in. You can add movement to activate the energy naturally. Just keep it simple, but just get the sunlight in that first 30 minutes.”— Reinforces morning practices for cortisol.
“In the evening time, if you want to add more supplements in, you could use magnesium glycinate. 3 400 milligs of magnesium glycinate. Torine. You could just do maybe like a gram of torine. You could also take this time to do simple box breathing.”— Provides specific evening recommendations for cortisol reduction.
“This is what I did not do. I was very overweight. I could not lose weight. I was working a stressful private equity job at the time and I would just stay clicked on all the time and then I would get home and I would remain on and I was not taking the measures to increase my parasympathetic system and relax.”— Personal experience illustrating the negative impact of unmanaged chronic stress/cortisol.

What's new

Personal practice updates, fresh positions, predictions

4 items

Metabolism isn't broken, it's stuck

0:30

The speaker argues that a slow metabolism isn't necessarily 'broken' but rather 'stuck' in an inefficient mode, often due to mitochondrial issues and hormonal imbalances, preventing effective energy conversion.

Why this matters: This reframes the common perception of a 'slow metabolism' from an irreversible state to a fixable one, offering hope and actionable strategies.

Background

Many people, including the speaker in his past, experience frustration when they feel they are doing everything right (eating clean, training hard, sleeping well) but still struggle with weight gain, fatigue, and a seemingly unresponsive metabolism.

The speaker describes a 'stuck metabolism' as a state where cells forget how to efficiently make energy. This isn't about a lack of energy, but rather the energy getting 'trapped upstream' because mitochondria, the cell's power plants, become overloaded or damaged. Instead of cleanly producing ATP, they leak electrons, creating reactive oxygen species (free radicals) that further damage the energy-producing machinery. This leads to a bottleneck where the body struggles to convert food into usable energy, causing fatigue even after eating and fat gain despite being in a caloric deficit. The body's 'hybrid engine' (ability to switch between burning carbs and fats) gets stuck in one gear.

Personal experience

The speaker recounts his own experience weighing 300 lbs, feeling like his metabolism was stuck despite not eating many calories and still gaining weight, and waking up tired even after sufficient sleep. He describes the frustration of trying various methods without success.

Your metabolism isn't really broken. It's just stuck in the wrong mode.

Also said
“It's about your cells sort of forgetting how to make energy. It comes down to really just not being able to partition things and turn them into energy properly.”— Explains the core issue at the cellular level.
“Your body's having a hard time converting food into motion, plain and simple. And that's why you end up even feeling fatigued after you eat because it's just creating this bottleneck.”— Connects the cellular mechanism to common symptoms like fatigue after meals.

Metabolic Inflexibility and Hormonal Misfires as Root Causes

3:40

The two primary reasons for a stuck metabolism are metabolic inflexibility (inability to switch fuel sources) and hormonal misfires, specifically involving thyroid and cortisol.

Why this matters: This provides a clear, two-pronged explanation for metabolic issues beyond simple calorie counting, highlighting specific biological pathways.

Metabolic inflexibility occurs when the body loses its ability to efficiently switch between burning glucose (from carbohydrates) and fat for fuel. Normally, enzymes like PDH burn glucose when insulin is high, and CPT1 burns fat when insulin is low. However, when PDH is shut down by PDK4 or CPT1 is blocked by melanol co-enzyme A, the body enters 'metabolic gridlock,' unable to burn either fuel effectively. This can even affect endurance athletes who restrict calories too much, leading their bodies to 'idle lower.' Additionally, a high NADH to NAD ratio signals energy overload to mitochondria, causing them to stop building new power plants (mitochondrial biogenesis), leading to a 'low power mode' despite efforts to train harder or fast longer. Hormonal misfires involve the thyroid and cortisol. The thyroid produces T4, but the body uses T3 for energy burning. The conversion of T4 to T3 is sensitive to stress, inflammation, and nutrient status. Caloric restriction and inflammation suppress the enzymes (D1 and D2) needed for this conversion, reducing T3 and thus the signal for cells to burn energy. Cortisol, while necessary in short bursts, becomes problematic when chronically elevated. Chronic cortisol increases fat-building enzymes (ACC and FASN) while suppressing fat-burning enzymes. It also activates PDK4, which blocks carbohydrate burning, creating a 'perfect storm' for fat storage when combined with insulin spikes.

There are two main culprits here. Number one is metabolic inflexibility and two is hormonal misfires.

Also said
“This is where you cannot burn carbs well and you cannot burn fat well. So, you're just sitting in neutral and you're revving this engine and it's not actually getting you anywhere.”— Illustrates the concept of metabolic gridlock.
“It showed that both caloric restriction and inflammation suppress these important enzymes. So when that happens, you produce less T3, less of that thyroid hormone, and your cells get less signal to burn that energy, making it feel like everything is stuck.”— Explains how caloric restriction and inflammation directly impair thyroid function.
“It showed that chronic [snorts] cortisol activates that same PDK4 I talked about earlier, which shuts off PDH, shuts off carbohydrate burning.”— Connects chronic cortisol to the mechanism of metabolic inflexibility.

Importance of Mineral Balance for Mitochondrial and Cortisol Health

9:00

Maintaining proper mineral balance, particularly electrolytes, is crucial for restoring mitochondrial health and cortisol balance, as minerals facilitate electrical signals necessary for cellular function.

Why this matters: This highlights a foundational, often overlooked aspect of metabolic health, emphasizing nutrient status over just calories.

Many people focus heavily on calorie intake but neglect the critical role of minerals. Minerals are essential for sending electrical signals to mitochondria, supporting muscle contraction, and overall tissue function. Good quality hydration and electrolytes are super important because they directly impact these cellular processes. The speaker specifically recommends a balanced electrolyte supplement to provide sodium, potassium, and magnesium, which are vital for these functions. This is particularly beneficial for those cutting calories, as it provides essential nutrients without adding caloric load, and can serve as a healthier alternative to sugary drinks.

People forget about that. They focus so much on calories that they forget like minerals are what send signals, electrical signals to the mitochondria, to other areas of the body.

The 'Recovery Oscillation' for Cortisol Rhythm

20:00

To prevent chronic cortisol elevation and metabolic stagnation, it's crucial to oscillate between high-stress periods (like fasting or intense training) and dedicated recovery days, rather than consistently pushing the body.

Why this matters: This challenges the common 'more is better' approach in fitness and diet, advocating for strategic rest and recovery as a metabolic tool.

The speaker emphasizes that continuous high-stress activities, whether from diet (constant low calories), training (back-to-back intense workouts), or other stressors, keep cortisol chronically elevated. This prevents the body from establishing a healthy cortisol rhythm, which is essential for metabolic function. The concept of 'recovery oscillation' means intentionally following a high-stress day (e.g., a fast or sauna session) with a dedicated recovery day. This pattern helps retrain the body's cortisol wave, allowing it to drop when it should. Without this oscillation, cortisol remains high, negating the benefits of other metabolic strategies. The speaker likens cortisol to the 'drummer of your metabolism' – if the beat is off, the whole band (metabolic processes) falls apart.

This oscillation retrains your cortisol wave, right? So the main thing is you don't want to fast or have super low calorie days back to back.

Also said
“Anytime you have a high stress day, whether it's through your diet, your training, or whatever, you need to contrast that with a relaxed day.”— Defines the core principle of recovery oscillation.
“Cortisol is the drummer of your metabolism. When that beat is off, the whole band falls apart.”— Provides a memorable analogy for cortisol's role.

Recommendations

Products, supplements, and tools mentioned in the episode

13 items

Niacinamide (Vitamin B3)

Supplement

Supports the recycling of NADH back into NAD, which is critical for mitochondrial health and energy production.

You can support this whole NADH to NAD process, this whole recycling with nioinamide. Okay? So, you have vitamin B3.

Find Niacinamide

Glycine

Supplement

Helps support the NADH to NAD recycling process.

You could have glycine like three grams of glycine

Find Glycine

Polyphenols (EGCG, Resveratrol)

Supplement

Activates C1 and PGC1 alpha, helping mitochondria learn to use fats again and reducing inflammation.

Polyphenols, such as those found in green tea (EGCG) or resveratrol, are recommended because they activate specific pathways (C1 and PGC1 alpha) that help mitochondria become more efficient at burning fats. This is crucial for metabolic flexibility. Additionally, these compounds contribute to reducing inflammation, which is a key factor in blocking T3 production and overall metabolic dysfunction.

Then take polyphenols like drinking green tea or straight up take EGCG or even resveratrol is really good for this. What that can do is it activates something called C one and PGC1 alpha. This helps the mitochondria learn to use fats again.

Find Polyphenols

Selenium

Supplement

Essential for efficient T4 to T3 conversion, crucial for thyroid function.

Selenium is highlighted as a critical nutrient for thyroid health, specifically for the conversion of inactive T4 to active T3. This conversion is vital for cells to receive the signal to burn energy. While it can be obtained from food, supplementation is mentioned for simplicity. The speaker also notes that two Brazil nuts can provide the necessary selenium.

So, selenium, try about 200 micrograms. You can get it from good quality food, but let's just say supplements here just to make it simple.

Also said
“Or you can literally just eat some eggs with maybe a little bit of salmon, some locks, and like two Brazil nuts, okay? And that's going to get you the nutrients you need.”— Provides a food-based alternative for selenium intake.
Find Selenium

Zinc

Supplement

Important for thyroid function and the conversion of T4 to T3.

Anywhere from 15 to 50 millig of zinc, really important for thyroid function and that conversion.

Find Zinc

Tyrosine

Supplement

An inexpensive amino acid that supports thyroid function.

Tyroine, okay, really inexpensive amino acid. 500 milligrams to 1,000 milligs. Really simple and highly effective.

Find Tyrosine

Iodine

Supplement

Supports thyroid function, especially if deficient.

Now, sometimes people are low in iodine. So, maybe having like 100 to 200 micrograms of iodine, but also just having like a couple seaweed snacks. That's all you would need to have like a little couple little pieces of seaweed that big, right? Really simple. That gets you enough iodine to support thyroid function.

Find Iodine

Omega-3s

Supplement

Reduces inflammation, which can block T3 production.

You also want to make sure you're doing things to reduce inflammation. Okay? All kinds of lifestyle things there, but maybe 2,000 milligs of omega-3s, maybe taking in some curcumin.

Find Omega-3s

Curcumin

Supplement

Reduces inflammation, which can block T3 production.

You also want to make sure you're doing things to reduce inflammation. Okay? All kinds of lifestyle things there, but maybe 2,000 milligs of omega-3s, maybe taking in some curcumin.

Find Curcumin

Magnesium Glycinate

Supplement

Helps lower cortisol and activate the parasympathetic system in the evening.

In the evening time, if you want to add more supplements in, you could use magnesium glycinate. 3 400 milligs of magnesium glycinate.

Find Magnesium

Taurine

Supplement

Helps lower cortisol and activate the parasympathetic system in the evening.

Torine. You could just do maybe like a gram of torine.

Find Taurine

Red Light Therapy (Morning)

Tool

Morning red light or infrared light directly on the neck and chest to increase cytochrome oxidase activity and boost local T3 signaling.

Applying red light or infrared light directly to the thyroid area (neck and chest) in the morning is suggested as a 'creative way to enhance thyroid signaling.' This practice increases cytochrome oxidase activity, which is part of the mitochondrial electron transport chain where energy is manufactured. By boosting this activity locally at the thyroid level, it enhances local T3 signaling, effectively telling the cells in that region to burn more energy. The speaker acknowledges it might sound 'sci-fi crazy' but asserts its effectiveness.

So morning red light or even infrared light or both directly on your neck and chest that increases what is called cytochrome oxidase activity. So you're having increasing the the last complex of the mitochondria where energy is really manufactured right at the actual thyroid level and this boosts what is called local T3 signaling.

Find Red

60-Second Cold Exposure

Practice

Brief cold showers to increase norepinephrine and enhance D2 enzyme activity, crucial for thyroid hormone production.

Even a short, 60-second cold shower is recommended for its metabolic benefits. This brief cold exposure increases norepinephrine, a neurotransmitter that plays a role in metabolism and energy expenditure. More importantly, it enhances the activity of the D2 enzyme, which is one of the key enzymes responsible for converting inactive T4 thyroid hormone into its active form, T3. This directly supports thyroid function and the body's ability to burn energy.

Another thing you can do is just 60 seconds of cold exposure. You don't need to go sit in a cold punch for 5 minutes. You can take a 60-second cold shower and this will increase norepinephrine and it enhances this D2 enzyme activity. this enzyme that's required for thyroid to be produced.

Find 60-Second
Disclosed sponsorships1speaker disclosed

Element Electrolytes

Supplement Sponsored · disclosed

Recommended for restoring mineral balance, which is crucial for mitochondrial health and cortisol balance. It provides essential electrolytes without calories.

DisclosureThe speaker provides a link for a free sample variety pack with any purchase at drinklnt.com/thomas.

The speaker highly recommends Element electrolytes, stating he has used them for seven years. He highlights their specific formulation: 1000mg sodium, 200mg potassium, and 60mg magnesium, calling it a 'perfect trifecta of minerals.' The main benefit is providing crucial minerals that send electrical signals to mitochondria and support various bodily functions, especially when cutting calories. It also serves as a tasty, calorie-free alternative to diet sodas or regular sodas, helping with hydration and mineral intake.

Personal experience

The speaker states, 'They're ones that I've been using for 7 years now.'

They're called Element, and it's 1,000 milligs of sodium, 200 milligs of potassium, and 60 milligs of magnesium. So, it's a really perfect trifecta of minerals.

Find Element

Notable quotes

Lines worth pulling out — contrarian, specific, or perfectly phrased

4 items
Your metabolism isn't really broken. It's just stuck in the wrong mode.
This is the central thesis of the video, reframing metabolic issues from a permanent problem to a solvable one.
It's basically like your thyroid is shouting, saying, "Hey, I'm over here." But the mitochondria has like earplugs in and simply can't hear it. So, it's not responding to it.
Provides a vivid and relatable analogy for thyroid hormone resistance at the cellular level.
Cortisol is the drummer of your metabolism. When that beat is off, the whole band falls apart.
A powerful metaphor illustrating the critical role of cortisol rhythm in overall metabolic harmony.
So, it's not so much that the metabolism isn't working. It's just the energy is there. It's just getting trapped upstream and can't actually get down to what you want, which is translatable energy.
Clarifies that the problem isn't a lack of energy, but an inability to utilize it, explaining fatigue despite caloric intake.

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Topics covered

stuck metabolismmitochondrial dysfunctionmetabolic inflexibilityhormonal misfiresthyroid healthcortisol rhythmredox balancenadh to nad ratiocarbohydrate refeedsclean carbsniacinamideglycinepolyphenolsegcgresveratrolmethylene bluemottz c peptidefastingautophagymitophagy
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Educational summary of the cited expert source — not medical advice. Open the source recording linked above and consult a qualified physician before acting on any protocol.